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Volunteer Application

Date:

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Email:

Volunteer opportunity you are interested in (check all that apply):
 Directly with residents/clients Agency Sponsered Events/Activities Childcare Center

References: Please list two (2) persons not related to you whom we may contact
Phone:
Phone:

Are you volunteering to meet class requirement?
 Yes No

Please list specific days and times you are interested in volunteering directly with the residents or consumers:

Or, please list specific events you may be interrested in volunteering for:

What are you hoping to achieve by volunteering for Hills & Dales?

Have you ever been convicted of a crime?:
 Yes No

If Yes, please explain

Recreation Activities

Please check those of interest

Art
 Drawing Painting Coloring Play Instruments Voice Lessons/Singing

Community
 Sport Events Shopping Out to Eat Rec. Center Movie Theaters Concerts Library Zoo Field Trips Clubs/Bars Musicals Museums Coffee Houses Church Special Olympics

Crafts
 Crochet/Knit Clay/Ceramics Needle Point Latch Hook Woodworking Sewing Cross Stitch Plastic Crafts Embroidery

Games
 Card Games Puzzles Lawn Games Video Games Word Search Board Games Crossword Puzzles

Hobbies
 Models Collections Photography Other

Miscellaneous
 Cooking TV Magazines Tapes/CDs Renting Videos Writing Reading Other

Physical
 Team Sports Individual Sports Swimming Ping Pong/Pool Bicycling Bowling Skiing Dancing Football Aerobics Tae Kwon Do/Karate Gymnastics Softball Basketball Golf Weightlifting

Outdoor
 Picnics Walking/Hiking Car Rides Rollerskating Nature Activities Gardening Fishing Boating Camping Ice Skating Roller-blading Hunting Go to a park Sledding